Risk factors for and clinical outcomes of carbapenem non-susceptible gram negative bacilli bacteremia in patients with acute myelogenous leukemia

• Published in: BMC infectious diseases Vol. 20; no. 1; pp. 404 - 7
• Main Authors: Shin, Dong Hoon, Shin, Dong-Yeop, Kang, Chang Kyung, Park, Suhyeon, Park, Jieun, Jun, Kang Il, Kim, Taek Soo, Koh, Youngil, Hong, Jun Shik, Choe, Pyoeng Gyun, Park, Wan Beom, Kim, Nam-Joong, Yoon, Sung-Soo, Kim, Inho, Oh, Myoung-Don
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 09.06.2020; BioMed Central; BMC
• Subjects: Acinetobacter baumannii - drug effects; Acinetobacter baumannii - isolation & purification; Acute myelocytic leukemia; Acute myelogenous leukemia; Acute myeloid leukemia; Adult; Aged; Anti-Bacterial Agents - pharmacology; Antibiotics; Antineoplastic Agents - therapeutic use; Bacilli; Bacteremia; Blood pressure; Carbapenem non-susceptible; Carbapenems - pharmacology; Case-Control Studies; Chemotherapy; Clinical outcomes; Confidence intervals; Drug Resistance, Bacterial; Female; Gram negative bacilli; Gram-Negative Bacterial Infections - complications; Gram-Negative Bacterial Infections - diagnosis; Gram-Negative Bacterial Infections - microbiology; Gram-Negative Bacterial Infections - mortality; Hospital Mortality; Humans; Infections; Infectious diseases; Leukemia; Leukemia, Myeloid, Acute - complications; Leukemia, Myeloid, Acute - drug therapy; Leukemia, Myeloid, Acute - pathology; Male; Middle Aged; Mortality; Myeloid leukemia; Neutropenia; Odds Ratio; Pathogens; Patient outcomes; Patients; Retrospective Studies; Risk analysis; Risk Factors; Sepsis; Tertiary Care Centers; Treatment Outcome; Acute myelogenous leukemia; Gram negative bacilli; Bacteremia; Risk factors; Carbapenem non-susceptible
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-020-05131-2

Carbapenem is frequently used when gram negative bacilli (GNB) bacteremia is detected especially in neutropenic patients. Consequently, appropriate treatment could be delayed in GNB bacteremia cases involving organisms which are not susceptible to carbapenem (carba-NS), resulting in a poor clinical outcomes. Here, we explored risk factors for carba-NS GNB bacteremia and its clinical outcomes in patients with acute myelogenous leukemia (AML) that underwent chemotherapy. We reviewed all GNB bacteremia cases that occurred during induction or consolidation chemotherapy, over a 15-year period, in a tertiary-care hospital. Among 489 GNB bacteremia cases from 324 patients, 45 (9.2%) were carba-NS and 444 (90.8%) were carbapenem susceptible GNB. Independent risk factors for carba-NS GNB bacteremia were: carbapenem use at bacteremia onset (adjusted odds ratio [aOR]: 91.2; 95% confidence interval [95%CI]: 29.3-284.1; P < 0.001); isolation of carbapenem-resistant Acinetobacter baumannii (aOR: 19.4, 95%CI: 3.4-112.5; P = 0.001) in the prior year; and days from chemotherapy to GNB bacteremia (aOR: 1.1 per day, 95%CI: 1.1-1.2; P < 0.001). Carba-NS bacteremia was independently associated with in-hospital mortality (aOR: 6.6, 95%CI: 3.0-14.8; P < 0.001). Carba-NS organisms should be considered for antibiotic selection in AML patients having these risk factors.